Organization
SPACE COAST CARDIOLOGY CONSULTANTS
Active
Organization
SPACE COAST CARDIOLOGY CONSULTANTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURIE HOLLAND (ADMINISTRATOR)
(352) 362-4223
Entity
Organization
Contact information
Practice address
7139 NORTH HIGHWAY US # 1, PORT ST JOHN, FL 32927-5094
(321) 635-8304
(321) 635-8252
Mailing address
7139 NORTH HIGHWAY US # 1, PORT ST JOHN, FL 32927-5094
(321) 635-8304
(321) 635-8252
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CL3045
RAILROAD MEDICARE
FL
Enumeration date
07/13/2006
Last updated
04/07/2025
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